Promoting Midwifery Care for All Saskatchewan Women

May 5th is the International Day of the Midwife, a day that is recognized around the world as an opportunity to celebrate midwifery and to promote awareness of the care that midwives provide. On March 14, 2008, midwifery became a regulated profession in Saskatchewan, joining 7 other provinces and territories to offer a safe alternative to traditional physician care. Two years later, many people still do not understand the role of a Midwife and are not aware that midwifery care is an available option for some women.

• Midwives are specialists in normal birth, providing primary care for women and babies throughout pregnancy, labour, childbirth, and first 6 weeks postpartum.

• Midwives are able to do deliveries in hospitals or at home, and they are trained to provide immediate emergency care to the mother and newborn.

• Midwives provide women with information and options regarding their care, encouraging informed consent, and follow guidelines that determine whether a medical condition or complication indicates a need for physician consult or transfer of care.

• Midwives are able to order diagnostic tests and assessments, prescribe and administer many drugs commonly used in pregnancy, childbirth, and immediate postpartum period.

• Midwifery care reduces the rates of intervention including cesarean section, result in shorter hospital stays, increased success rates of breastfeeding, and reduce health care costs.

There are currently over 800 Registered Midwives throughout Canada, with over half of those in Ontario alone. Despite having the most Registered Midwives in Canada, the demand for midwifery services is so great that more than 40% of women seeking midwifery care in Ontario are turned away due to a full case load. Across Canada, almost all other provinces are experiencing the same difficulties with meeting the demand for midwifery services.

Despite the goal of Saskatchewan Health to make midwifery care accessible to all women in the province, full scope of midwifery services is only available to women who live within the Saskatoon city limits. The Saskatoon health region has only five Registered Midwives and due to the demand for services, these midwives are not able to accept clients outside of Saskatoon which leaves women in other communities and rural areas without access to midwifery care. Regina Qu’Appelle and Cypress health regions are in the process of recruiting midwives but services will be limited until more midwives are hired. Until the Saskatchewan Government provides funding for independent midwifery services, rural women will continue to have insufficient access to midwifery care.

In order for midwifery care be accessible to all women in Saskatchewan, funded Independent Practice is an option that must be considered. Although independent midwifery practice is a legal option in Saskatchewan, the midwife must first obtain liability insurance in order to be eligible for registration (legally allowing her to practice). Liability insurance costs $25,000 - 50,000 each year, in addition to all other business expenses such as emergency training courses, supplies, and equipment; a prohibitive amount of money for a midwife in independent practice. As well, until the Saskatchewan government provides funding for independent practice, clients must pay the midwife “out of pocket” for independent midwifery services, a service that is free for Saskatoon (urban) women. Midwifery service fees range from $2500 - $3100 per course of care. For those health regions that employ midwives, expenses such as liability insurance, supplies, equipment, emergency training courses, and office and clinic space are all paid for by the health region. These health regions also pay the midwives’ salaries so midwifery care is “free” to women in that area.

Obstacles to having midwifery care accessible to all women in Saskatchewan:

• Only four provinces in Canada offer university midwifery education programs, and Saskatchewan does not have one.

• A full range of midwifery care is only available to women within the city limits of Saskatoon at this time.

• Two other health regions are in the process of hiring midwives who will be limited in the care they can provide, such as providing care only to women who choose to birth in a hospital.

• Home birth with a Registered Midwife is not an option for women outside of Saskatoon.

• Rural women in Saskatchewan have no access to midwifery care and most women have to travel long distances to receive prenatal care and give birth in hospitals.

• The costs required for midwives to set up independent practice are prohibitive.

• Although Saskatchewan Health has provided funding for midwifery services, it is not known when ten of the 13 regional health authorities in Saskatchewan (including Saskatoon District Health Region) are planning to implement further midwifery care.

• Saskatoon’s midwifery program automatically discriminates against women who live rurally, but within the health district, by disqualifying based on their address. Thus more than half of the SDHR families who chose midwifery in 2008, before regulation went into effect, now have no access to this important form of maternity care. The SDHR has placed a hiring freeze in 2010 its midwifery program, even though the demand is high and waiting lists are long. There can be no waiting lists in maternity care. This makes it imperative to provide access to independent midwifery services now.

• Submitted by Midwifery For All, a consumer group for the advancement of midwifery services in Saskatchewan. For more information contact Amy at amycassonis@gmail.com or midwiferyforall@yahoogroups.ca